Laserfiche WebLink
` E - Wastea Tire ey . & Inspection Re 'rt SURVEY REQUIRED <br /> =. iforni <br /> CIWMB 182 New 04/04 <br /> t 1 <br /> California lAtegratedWasteManagementBoard Inspection Form Page <br /> Part C - Fat:ilit Information -� BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> tns ection <br /> Report <br /> NSe Suffix: I j ( jo j umber: <br /> P1 <br /> SWIS [1-1 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Number: ELI <br /> ! J= Photos Taken Q Yes O No <br /> Property Owner <br /> Name Phone Number I Mailing Address City State ZIP Code <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory ryStatus (Fill one) <br /> o PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption O Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> o PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ��� ® Excluded O Unpermitted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or baT&st Facility Type(Fill one) <br /> ® 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises O Major WTF (?5,000 Tires) <br /> O 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> Q 14 CCR§18420(a (7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days O Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility x <br /> V A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 14 CCR§17352-Site Security <br /> O O PRC§42824-Major Waste Tire Facility Permit ® (a)Signs! O (b)Site Attendant O (c)Access <br /> O O PRC§42834-Minor Waste Tire Facility Permit 14 CCR§17353(a)-Vector Control <br /> O O PRC§42850(a)-Complies with Terms of Permit ® (1)Impe meable Barrier ® (2)Approv6`d'Vector Plan <br /> F0 07. 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> Q Q 14 CCR§18423--Filing Application for Permit 0 (b)Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> � <br /> 101 0 1 14 CCR§18433-Emergency Response Plan 0 (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement Q (f)Siting(New Facilities) <br /> Q Q 14 CCR§18447-Records Available Q (g)Rim Removal <br /> 14 CCR§17351-Fire Prevention Measures Q (h) Protection from Pyrolytic Oil.Runoff <br /> 0 (a)Communication Equipment Q (c)Water Supply14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment Q (d)Other Requirements . Facility Compliance with NFPA 231D-1989 <br /> Comments Ma <br /> {�Li _esf (q�,�t—a, JAC51-��f5 � —��,L� ��LC- <br /> �� .Y�t ,�WC.� �.Q..CZ_� (�►'�.2. I j jyl/t/'Irt..Q 4fL-t w +' — <br /> I no ,4 nL Do-A rL _S' Y�' _96_yians_� <br /> lium-'45t S cJenI o ee _INS rcuSse Oki <br /> r(aHC C W�dk AA - �,� C rv�at�� PS fr a c fPa_ AY'. <br /> 5 a(( nc owed-S hlae <br /> '-- �; ,►r�;Ir 15386 <br /> INSTRUCTIONS ON BACK Correct:9 Incorrect: � } � E Xp I_ EZ'S 3 <br /> ■. White Copy:CIWMB r Yellow Copy:Operator Pink Copy:LEA ® ■ <br />